31 - Micturition Disorders and UTIs

Storage

Micturition disorders of what can include small-normal bladder, and three differentials: urethral sphincter mechanism incompetence, ectopic ureters, and overactive bladder?

Voiding

Micturition disorders of what occur when there is a large bladder, and have three differentials: mechanical obstruction, functional obstruction, and atonic bladder?

Micturition

What disorders, which can be storage or voiding, are approached by PE, pre and post-voiding residual bladder volume, urinalysis, urine culture, radiographs, diagnostic ultrasound, and treatment trials? Advanced imaging will require referral, such as MRI for neurogenic disorders and urodynamic studies (rare).

Urethral

Storage micturition disorders due to incompetence of what sphincter mechanism occur when the smooth muscle in this structure has decreased tone, and is most common in middle-older spayed female dogs? Large breeds are predisposed, and there is increased incidence with early spaying. Decreased estrogen will cause decreased alpha-adrenergic response and decreased vascularity, causing this condition. Signs include urine dribbling in sleep, and diagnosis is by suspicion and rule-outs.

Sympathomimetic

What type of treatment is tried first for urethral sphincter tone problems, and involves Phenylpropanolamine (PPA), an alpha-agonist? Side effects of this include hypertension.

Hormonal

What type of treatment for urethral sphincter tone problems after sympathomimetic treatment with PPA? It can include estrogen for female dogs (causes hair loss, behavioral problems, and BM suppression), or testosterone for male dogs. If this fails, then surgery with hydraulic occluders or bulking agent injections can be tried.

Bladder

Storage micturition disorders due to an overactive what organ occurs due to increased function of the detrusor muscle? Signs include pollakiuria and a perpetually small this structure. Diagnosis is with rule-outs and treatment can include anti-spasmodic, anti-cholinergic, and anti-muscarinic treatments, such as oxybutynin.

Overflow

What type of incontinence is a micturition voiding disorder which presents as incontinence, but is actually just due to an overfull bladder that is nevertheless normal?

Skeletal

Relaxer drugs to what type of muscle include Diazepam, dantrolene, and baclofen, are used to treat voiding micturition disorders due to functional obstruction?

Smooth

Relaxer drugs to what type of muscles include tamsulosin, prazosin, and phenoxybenzamine, plus other alpha antagonists, and are used to treat micturition voiding disorders due to functional obstruction?

Bethanechol

What drug is a cholinergic muscarinic agonist used to treat atonic bladder (micturition voiding disorder) by increasing bladder muscle contractions?

Dyssynergia

Reflex what condition is when there is incoordination of the detrusor muscle contraction with urethral sphincter relaxation? It can be secondary to spinal cord disease or idiopathic, and is treated by: smooth muscle relaxation trial, skeletal muscle relaxation trial, and possibly detrusor muscle contraction trial.

Relapsing

What type of recurrent UTIs are when the UTI is cleared but returns with the same organism?

Refractory

What type of recurrent UTI is also called persistent, and is when the Same organism is still causing the UTI and is not clearing with treatment?

Reinfection

What type of recurrent UTIs are a new UTI caused by a new organism?

Superinfection

What type of recurrent UTI is when there is a new organism infecting the patient while the UTI is still being treated? This is rare and is often due to neoplasia, cystotomy tube, or indwelling catheter.

Dilute

Will animals with more dilute or concentrated urine be more prone to recurrent UTIs?

7-14

The new guidelines for treating a recurrent UTI is to treat for about how many days? The old guidelines were 4-6 weeks. If clinical signs persist, the culture is repeated one week after treatment. Bacterial prostatitis will take 4-6 weeks of treatment, and struvite stone formation occurs due to UTI.